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HomeMy WebLinkAboutBLDG-22-003701 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE January 04,2022 PERMIT# BLDG-22-003701 JOBSITE ADDRESS 904 ROUTE 6A OWNER'S NAME JOYCE PATRICK H JR G OWNER ADDRESS JOYCE ROBERTA M 32 CHARING CROSS RD SO DENNIS MA 02660 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO©' FIXTURES FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 _ BOOSTER _ CONVERSION BURNER _ COOK STOVE _ DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM!SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES © NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER OF INDEMNITY El BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that at plumbing work and installations performed under the permit issued for this application will be in compliance with at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Michael Grillo LICENSE# 33651 SIGNATURE MP 0 MGF❑JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑tt LLC❑# COMPANY NAME Thonus North PHAC ADDRESS. 12 Mohegan Lane, CITY Yarmouth Port STATE MA ZIP 02675 TEL 5084301150 FAX CELL EMAIL S310N M3IAal NVlld #11WN3d $ :33d ❑ ❑ 11W2I3d 3HI SV S3Ad3S NOIlv011ddd SIHJ oN saA S310N NO1103dSNI 1VNId )llNO 3Sf1 NO103dSNI Wd 30Vd SIH1 S310N N01103dSNI SVO HOflO I